Central Nervous System Lymphoma.

Central nervous system lymphoma (CNSL) is a rare and aggressive malignancy that primarily affects the brain, spinal cord, and meninges. This article provides a comprehensive overview of the current understanding of CNSL encompassing its epidemiology, pathophysiology, clinical presentation, diagnosis, treatment modalities, and prognosis. Although the main focus is on primary CNS lymphoma (PCNSL), ocular lymphoma, primary leptomeningeal lymphoma, and secondary CNS lymphoma are also discussed. The pathobiology of CNSL involves the infiltration of malignant lymphocytes within the CNS parenchyma or leptomeninges. Various risk factors and immunological mechanisms contribute to its development, including immunodeficiency states, chronic inflammation, and genomic alterations. Accurate diagnosis is crucial for appropriate management, given the heterogeneous clinical presentation. The neuroimaging, systemic imaging, and other modalities for diagnosis and evaluation for extent of disease involvement will be discussed. Additionally, the importance of histopathological examination, cerebrospinal fluid (CSF) analysis, and molecular testing in confirming the diagnosis and guiding treatment decisions are highlighted. The treatment landscape for CNSL has evolved significantly. Therapeutic approaches encompass a multimodal strategy combining high-dose methotrexate-based chemotherapy, consolidation with whole-brain radiation therapy, and high-dose chemotherapy with stem cell rescue. Recent advancements in targeted therapies and immunomodulatory agents offer promising avenues for future treatment options. We review the clinical outcomes and prognostic factors influencing the survival of CNSL patients, including age, performance status, disease stage, and genetic abnormalities.

The precision of case difficulty and referral decisions: an innovative automated approach.

OBJECTIVES: Endodontic treatment works as a successful treatment modality in several cases. However, it may fail due to some reasons unforeseeable by the dentist. Many failures can be prevented by carefully assessing the difficulty level of the case before initiating treatment or by referral to a specialist. This study presents an approach using machine learning to generate an algorithm which can help predict the difficulty level of the case and decide about a referral, with the help of the standard American Association of Endodontists (AAE) Endodontic Case Difficulty Assessment Form. MATERIALS AND METHODS: Using the AAE Endodontic Case Difficulty Form after obtaining the patients' consent, 500 potential root canal patients were diagnosed. The filled forms were assessed by two pre-calibrated endodontists, and, in cases of conflicting opinion, a third endodontist's opinion was taken. Artificial neural network was used for generating the algorithm. RESULTS: Using 500 filled AAE forms, a sensitivity of 94.96% was achieved by the machine learning algorithm. CONCLUSION: This study provides an option for automation to the conventional method of predicting the difficulty level of a case, thus increasing the speed of decision-making and referrals if necessary. CLINICAL RELEVANCE: An AAE Endodontic Case Difficulty Assessment Form when utilized along with machine learning can assist general dentists in rapid assessment of the case difficulty. This is a helpful tool in developing countries, where endodontic treatment and referral guidelines are often neglected. It also helps to make difficulty level assessments easier for novice practitioners, when they are in doubt about the same.

Traumatic Vertebral Artery Dissection and Basilar Artery Occlusion/Stroke in a 7-Year-Old Child: A Case Report.

Vertebral artery dissection (VAD) followed by basilar artery occlusion/stroke (BAO/BAS) is a rare but potentially life-threatening complication. We present a case report of a 7-year-old boy with VAD complicated by BAO/BAS 4 days after falling off a scooter. Symptoms included left-sided weakness and facial droop preceded by a 20-minute episode of altered sensorium. Magnetic resonance imaging showed ischemic changes in the left posterior inferior cerebellum and right pons. Computed tomography angiogram confirmed dissection of the left vertebral artery with occlusion/thrombosis of the basilar artery. Heparinization for 96 hours, followed by 6 months of low-molecular weight heparin injection, resulted in improvement of his neurological symptoms.

Effect of commonly used irrigants on the colour stabilities of two calcium-silicate based material.

PURPOSE: The aim of present study was to evaluate the color stability of calcium-silicate based cements (CSC) Mineral Trioxide Aggregate (MTA) and BiodentineTM when exposed to endodontic irrigating solutions 5% Sodium hypochlorite (NaOCl) or 2% Chlorhexidine (CHX). MATERIALS AND METHODS: A total of 60 (n=30) cylindrical samples (10 mm diameter, 2 mm height) were prepared by manipulating white MTA Angelus (Angelus, Londrina, PR, Brazil) and BiodentineTM (Septodent, Saint Maur, France) according to manufacturer's instructions. These samples were immersed in 5% sodium hypochlorite (Prime Dental Products Pvt. Ltd., Mumbai, India), 2% chlorhexidine gluconate (Dentochlor, Saronno VA, Italia), or distilled water for 24 hours. Color changes were measured using UV spectrophotometer (UV-1650, Shimadzu, Europe) and the values were tabulated. RESULTS: A significant difference was observed between group I and II with respect to both parameters A & B (p<0.05). Both the calcium-silicate-based materials exhibited significant discoloration when immersed in NaOCl and CHX. Distilled water did not cause clinically perceptible discoloration of any material. CONCLUSION: A significant discoloration was observed with a specific combination of calciumsilicate- based cement and irrigant. BiodentineTM exhibited significant discoloration with CHX whereas, MTA showed more discoloration with NaOCl.

Percutaneous microdiscectomy versus epidural injection for management of chronic spinal pain.

In this study we present the efficacy of aspiration of disc material employing the Stryker Disc Dekompressor during percutaneous microdiscectomy for the treatment of chronic spinal and radicular pain due to contained lumber disc herniation and compare the short-term outcome in such patients with those who received lumber epidural injection. A total of 50 patients with chronic lumber discogenic pain and radiculopathy were enrolled in this study and were randomized into two groups. Group 1 (n=26) underwent first time, single-level lumber discectomy at either L3-4, L4-5, or L5-S1 using the Stryker Disc Dekompressor for aspiration of disc material and Group 2 (n=24) received epidural steroid/local anesthetic injection. Data on patient demographics, operative time, length of hospitalization, incidence of postoperative complications, analgesic usage and postoperative complications were obtained. For short-term evaluation of the outcome in the two patient groups, the Visual Analogue Scale (VAS) from 0-10 for back pain and radicular pain were obtained preoperatively, 24 hr and 1-6 wk postoperatively. Also, the straight leg raising test (SLRT) was performed and recorded. A significant decrease in the radicular pain scores and an increase in SLRT degrees with a decrease in the back pain scores was seen in the disc Dekompressor group with minimal incidence of postoperative complications. In the epidural injection group, the back pain scores were significantly decreased postoperatively while the radicular pain and the SLRT degrees were insignificantly changed 24 hr postoperatively and at wk 6. We conclud that when standardized patient selection criteria are used, the disc DeKompressor is a safe and more effective treatment for radicular pain of discogenic origin than epidural injection with steroid/local anesthetic. Back pain of discogenic origin was more effectively treated with the epidural steroid/local anesthetic injection. Treatment of patients with radicular pain associated with contained disc herniation using the Dekompressor can be a safe and more effective procedure.

Efficacy of postoperative continuous wound infiltration with local anesthetic after major abdominal surgery.

The aim of this study was to evaluate the analgesic efficacy, safety, opioid sparing effects and improvement of respiratory function when using 0.2% ropivacaine continuous wound infiltration after major intra-abdominal surgery. Forty patients undergoing major intra-abdominal surgery requiring a midline incision of > or = 20 cm were enrolled into this IRB-approved, randomized, prospective controlled study. Group 1: 20 patients, parenteral analgesia (control group). Group II: 20 patients, with local anesthetic wound infiltration (pain pump group). At the end of the procedure, in the pain pump group of patients, a multi hole, 20-gauge catheter was inserted percutaneously, above the fascia. An initial dose of 10 ml of 0.2% ropivacaine was injected in the wound through the catheter. A device provided continuous delivery of 0.2% ropivacaine; the infusion was initiated at 6 ml/h for the following two days. The total "rescue" morphine and oxycodone/acetaminophen tablets administered were significantly lower in the pain pump group. At all time intervals, resting pain scores were significantly lower in the pain pump group when compared with the control group. However, at the 4-48 and 12-48 hours pain scores generated after leg raise and coughing, respectively, were significantly lower in group II. The patient vital capacities were insignificantly higher in group II. We conclude that after major abdominal surgery, infiltration and continuous wound instillation with 0.2% ropivacaine decreases postoperative pain, opioid requirements and oral analgesia. Early patient rehabilitation, hastening convalescence, and preventing respiratory complications are expected outcomes of this approach.